Rhabdomyolysis - An evaluation of 475 hospitalized patients
Rhabdomyolysis - An evaluation of 475 hospitalized patients
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DOI：
10.1097/01.md.0000188565.48918.41
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发表时间：
2005-11-01
期刊：
影响因子：
1.6
通讯作者：
Cornblath, DR
中科院分区：
文献类型：
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作者：
Melli, G;Chaudhry, V;Cornblath, DR
横纹肌溶解症是一种常见的和潜在致命的临床综合征，由急性肌纤维坏死导致肌肉成分渗漏到血液中。肌红蛋白尿是最显著的后果，导致15%-33%的横纹肌溶解症患者发生急性肾功能衰竭（ARF）。横纹肌溶解症发生于遗传性疾病、毒素、肌肉压迫或过度用力、或炎症过程以及其他疾病。我们描述了1993年1月至2001年12月间约翰霍普金斯医院住院记录中的475例患者，其出院诊断代码如下：肌红蛋白尿、横纹肌溶解、肌病、中毒性肌病、恶性高热、神经阻滞剂恶性综合征和多发性肌炎。在1362例患者中，纳入了475例血清肌酸激酶（CK）超过正常上限5倍（> 975 IU/L）的急性神经肌肉疾病患者。排除近期心肌梗死或卒中患者。通过病历审查确定病因。对于所有患者，记录了血清CK、血清肌酐和尿肌红蛋白、血红蛋白和红细胞的最高值。41例患者在至少2个月内进行了肌肉活检。在475名患者中，151名为女性，324名为男性（中位年龄，47岁;范围，4-95岁）。外源性毒素是横纹肌溶解症最常见的原因，其中非法药物，酒精和处方药占46%。在医疗药物中，抗精神病药、他汀类药物、齐多夫定、秋水仙碱、选择性5-羟色胺再摄取抑制剂和锂是最常见的药物。在60%的病例中，存在多种因素。在所有病例中，11%的横纹肌溶解症复发。10%的病例有潜在的肌病或肌肉代谢缺陷，其中复发率高，只有一种病因，ARE的发生率低。7%的病例没有找到病因。218例（46%）患者出现ARF，16例死亡（3.4%）。CK与肌酐、多因素与ARF呈直线相关，而ARF与死亡、多因素与死亡均无相关性。尿肌红蛋白试纸法/超滤法检测阳性率仅为19%。毒素是横纹肌溶解症最常见的病因，但大多数病例存在一种以上的病因。使用违禁药物或处方综合疗法的患者有横纹肌溶解症的风险。通过定性分析，尿肌红蛋白的缺乏不能排除横纹肌溶解。如果照顾得当，死亡是罕见的。
Rhabdomyolysis is a common and potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. Myoglobinuria is the most significant consequence, leading to acute renal failure (ARF) in 15%-33% of patients with rhabdomyolysis. Rhabdomyolysis occurs from inherited diseases, toxins, muscle compression or overexertion, or inflammatory processes, among other disorders. In some cases, no cause is found.We describe 475 patients from the Johns Hopkins Hospital inpatient records between January 1993 and December 2001 for the following discharge diagnosis codes: myoglobinuria, rhabdomyolysis, myopathy, toxic myopathy, malignant hyperthermia, neuroleptic malignant syndrome, and polymyositis. Of 1362 patients, 475 patients with an acute neuromuscular illness with serum creatine kinase (CK) more than 5 times the upper limit of normal (> 975 IU/L) were included. Patients with recent myocardial infarction or stroke were excluded. The etiology was assigned by chart review. For all, the highest values of serum CK, serum creatinine and urine myoglobin, hemoglobin, and red blood cells were recorded. Forty-one patients had muscle biopsy within at least 2 months from. the onset of rhabdomyolysis.Of the 475 patients, 151 were female and 324 were male (median age, 47 yr; range, 4-95 yr). Exogenous toxins were the most common cause of rhabdomyolysis, with illicit drugs, alcohol, and prescribed drugs responsible for 46%. Among the medical drugs, antipsychotics, statins, zidovudine, colchicine, selective serotonin reuptake inhibitors, and lithium were the most frequently involved. In 60% of all cases, multiple factors were present. In 11% of all cases, rhabdomyolysis was recurrent. Underlying myopathy or muscle metabolic defects were responsible for 10% of cases, in which there was a high percentage of recurrence, only 1 etiologic factor, and a low incidence of ARE In 7%, no cause was found. ARF was present in 218 (46%) patients, and 16 died (3.4%). A linear correlation was found between CK and creatinine and between multiple factors and ARF, but there was no correlation between ARF and death or between multiple factors and death. Urine myoglobin detected by dipstick/ultrafiltration was positive in only 19%.Toxins are the most frequent cause of rhabdomyolysis, but in most cases more than 1 etiologic factor was present. Patients using illicit drugs or on prescribed polytherapy are at risk for rhabdomyolysis. The absence of urine myoglobin, by qualitative assay, does not exclude rhabdomyolysis. With appropriate care, death is rare.